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[Preprint]. 2023 Mar 17:2023.03.16.23287373.
doi: 10.1101/2023.03.16.23287373.

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

Noa Krawczyk  1 , Bianca D Rivera  1 , Carla King  1 , Bridget C E Dooling  2
Affiliations

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

Noa Krawczyk et al. medRxiv. .

Update in

Abstract

Buprenorphine is a highly effective treatment for opioid use disorder and a critical tool for addressing the worsening U.S. overdose crisis. However, multiple barriers to treatment - including stringent federal regulations - have historically made this medication hard to reach for many who need it. In 2020, under the COVID-19 Public Health Emergency, federal regulators substantially changed access to buprenorphine by allowing prescribers to initiate patients on buprenorphine via telehealth without first evaluating them in person. As the Public Health Emergency is set to expire in May of 2023, Congress and federal agencies can leverage extensive evidence from studies conducted during the wake of the pandemic to make evidence-based decisions on the regulation of buprenorphine going forward. To aid policy makers, this review synthesizes and interprets peer-reviewed research on the effect of buprenorphine flexibilities on uptake and implementation of telehealth, and its impact on OUD patient and prescriber experiences, access to treatment and health outcomes. Overall, our review finds that many prescribers and patients took advantage of telehealth, including the audio-only option, with a wide range of benefits and few downsides. As a result, federal regulators-including agencies and Congress-should continue non-restricted use of telehealth for buprenorphine initiation.

Keywords: COVID-19; buprenorphine; federal regulations; opioid use disorder; overdose; pandemic; policy translation; telehealth; telemedicine; treatment.

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Conflict of interest statement

Conflicts of Interest Noa Krawczyk provides expert testimony for ongoing opioid litigation

Figures

Figure 1.
Figure 1.
Studies considered and selected in the narrative review
See this image and copyright information in PMC

References

    1. CDC National Center for Health Statistics. Wide-Ranging Online Data for Epidemiologic Research (WONDER).; 2021.
    1. Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics. 2020;17(1):55–69. doi: 10.1007/s13311-019-00814-4 - DOI - PMC - PubMed
    1. Santo T Jr, Clark B, Hickman M, et al. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021;78(9):979–993. doi: 10.1001/jamapsychiatry.2021.0976 - DOI - PMC - PubMed
    1. Walsh S, Preston K, Stitzer M, Cone E, Bigelow GE. Clinical pharmacology of buprenorphine: Ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569–580. - PubMed
    1. Krawczyk N, Rivera BD, Jent V, Keyes KM, Jones CM, Cerdá M. Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019”. Int J Drug Policy. Published online August 4, 2022:103786. doi: 10.1016/J.DRUGPO.2022.103786 - DOI - PMC - PubMed

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